WVU Medicine neurosurgeons provide advanced care for patients using the latest technology to alter and, in some cases, improve the function of the human nervous system. This is called neuromodulation. This surgery is often done in a minimally or non-invasive manner and can have dramatic results. These are some of the ways this technology is being used:

Movement Disorders, including Parkinson’s Disease

Movement Disorders are neurological conditions that cause abnormal increased movements, which may be voluntary or involuntary. Many can be treated effectively with medicine, physical and occupational therapy, and other conservative measures. Over time, these methods may stop controlling the symptoms of the disease, and neuromodulation can offer significant benefits for these patients.

  • Dystonia is a condition involving sustained involuntary muscle contractions with twisting, repetitive movements. It can affect the entire body (generalized dystonia) or one part of the body (focal dystonia).
    • Symptoms:
      • Begins in a single area, such as the leg, neck, or arm
      • Occurs during a specific action, such as handwriting
      • Worsens with stress, fatigue, or anxiety
      • Becomes more noticeable over time
    • Neuromodulation Options:
      • Deep Brain Stimulation: Electrodes are surgically implanted into a specific part of the brain and connected to a generator implanted under the skin in the chest similar to a pacemaker. The generator sends electrical pulses to the brain that might help control muscle contractions.
  • Essential Tremor is a disorder that causes involuntary and rhythmic shaking. The trembling occurs most often in the hands but can affect almost any part of the body.
    • Symptoms:
      • Begins gradually, usually on one side of the body
      • Worsens with movement or postures
      • Usually occurs in the hands first, affecting one hand or both hands
      • Can include a “yes-yes” or “no-no” motion of the head
      • May be intensified by emotional stress, fatigue, caffeine, or temperature extremes
      • Usually runs in families
    • Neuromodulation Options:
      • Deep Brain Stimulation: Electrodes are surgically implanted into a specific part of the brain and connected to a generator implanted under the skin in the chest similar to a pacemaker. The generator sends electrical pulses to the brain that stop the abnormal circuitry causing the tremor.
  • Parkinson’s disease is a slowly progressive, neurodegenerative disorder that causes tremor; stiffness; slow, decreased movement; or imbalance.
    • Symptoms:
      • A tremor, or shaking, usually begins in a limb, often in the hand or fingers
      • Slowed movement over time
      • Rigid muscles
      • Impaired posture and balance
      • Loss of automatic movements
      • Speech changes
      • Writing changes
    • Neuromodulation Options:
      • Deep Brain Stimulation: Electrodes are surgically implanted into a specific part of the brain and connected to a generator implanted under the skin in the chest similar to a pacemaker. The generator sends electrical pulses to the brain that stop the abnormal circuitry causing the rigidity, slowness of movement, and tremor.

At WVU Medicine, there is a Parkinson’s support group that meets every month at HealthSouth in Morgantown.

Obsessive Compulsive Disorder

Obsessive Compulsive Disorder is a psychiatric disease marked by irresistible thoughts and urges. Treatment includes talk therapy and medication. In severe cases, when patients are resistant to these methods, neuromodulation surgery may have a role.

  • Neuromodulation Options:
    • Deep Brain Stimulation: Electrodes are surgically implanted into a specific part of the brain and connected to a generator implanted under the skin in the chest similar to a pacemaker. The generator sends electrical pulses to the brain that stops the abnormal circuitry causing the obsessive thoughts and urges.

Epilepsy

Epilepsy is a seizure when the brain has a burst of abnormal electrical signals over a short period of time. These signals cause the body and brain to react in certain ways. Anyone can develop epilepsy regardless of sex, race, ethnicity, and age. Most epilepsy can be controlled with medication, but a significant portion of patients with epilepsy continue to have seizures even with the best medical management. In the past, if these patients could not have curative surgery, there were no options for them. Now, neuromodulation can provide significant benefits in helping to control and limit their seizures.

  • Seizure Symptoms:
    • Temporary confusion
    • A staring spell
    • Uncontrollable jerking movements of the arms and legs
    • Loss of consciousness or awareness
    • Psychological symptoms, such as fear, anxiety, or déjà vu

At least two unprovoked seizures are generally required for an epilepsy diagnosis.

  • Neuromodulation Options:
    • Responsive Neurostimulation: Electrodes are surgically implanted into the brain in the areas that are most responsible for causing the epilepsy. They are connected to a generator that is implanted inside the skull. The generator can record seizures as they start and send signals back to the brain, causing the seizures to stop before they spread. This can prevent seizures from causing patients from losing consciousness and lower their number of seizures. Over time, the information gained from this device can allow some patients to have curative surgery for their epilepsy.
    • Vagal Nerve Stimulation: An electrode is surgically connected to the left vagus nerve and connected to a generator similar to a pacemaker. The generator can stimulate continuously in response to the patient’s heart rate or when the patient feels a seizure coming on. This device reduces the amount of seizures a patient suffers and decreases their overall severity.

Pain

Pain, such as angina (untreatable by other means), injuries to the spinal cord, nerve-related pain (such as severe diabetic neuropathy), peripheral vascular disease, complex regional pain syndrome, failed back syndrome, chronic radiculopathy, and other various types of pain, can be managed by spinal cord stimulation when conservative measures fail.

A spinal cord stimulator is an implanted device that sends low levels of electricity directly into the spinal cord.

Spinal cord stimulators come in three main types:

  1. Conventional implantable pulse generator, or IPG: A battery is placed in the spine during an operation. This can be a good choice for people with pain in just one body part because they need less energy to manage their pain.
  2. Rechargeable implantable pulse generator: A battery is placed in the spine during an operation. It can be recharged without another surgery. Because the energy source is rechargeable, these stimulators can put out more electricity. This may be a better choice for people with pain in the lower back or in one or both legs.
  3. Radiofrequency stimulator: This type of stimulator is an older design. It uses a battery that’s outside the body. This stimulator is rarely used today because of newer designs and better technology. This includes rechargeable batteries.

With all three types of spinal cord stimulators, the patient controls the level of electricity sent to the spine to make the treatment more effective.

Spasticity

Spasticity is a muscle control disorder that is characterized by tight or stiff muscles and an inability to control those muscles. Spasticity is caused by an imbalance of signals from the central nervous system to the muscles. It can be treated with a variety of conservative measures, including oral medications, muscle injections, physical and occupational therapy, and other options. When these fail, neuromodulation surgery may have a role.

  • Symptoms:
    • Increased muscle tone
    • Overactive reflexes
    • Involuntary movements, which may include spasms and clonus
    • Pain
    • Decreased functional abilities and delayed motor development
    • Difficulty with care and hygiene
    • Abnormal posture
    • Contractures (permanent contraction of the muscle and tendon due to severe persistent stiffness and spasms)
    • Bone and joint deformities
  • Neuromodulation Options:
    • Intrathecal Baclofen Therapy: Patients are given a trial dose of baclofen through a lumbar puncture. If the dose is effective in treating their symptoms, then a permanent pump and catheter can be implanted to deliver the drug continuously to the spinal fluid.
    • Selective Dorsal Rhizotomy: This is a surgery that stimulates the sensory nerves as they leave the spine using neuromonitoring in the muscles as well as physical therapy evaluations in the operating room to determine which sensory nerve roots are responsible for causing the spasticity in the muscles and then cutting only those. This can lead to dramatic improvements in spasticity of the legs without the need for permanent implants.

Research:

WVU Medicine is committed to advancing the frontiers of neuromodulation both in improving patient outcomes and broadening the applications for neuromodulation technology to help our patients. We are also using the unique opportunities afforded by neuromodulation technology to explore the basic functioning of the human mind. Our research efforts focus on addiction, cognitive and emotional functioning, pain, stroke recovery, unconscious body perception, balance and gait in Parkinson’s disease and other disorders, and many more.

Physicians:

Ali Rezai, MD – Executive Chair, WVU Rockefeller Neuroscience Institute

Ann Murray, MD

Nicholas Brandmeir, MD

Robert Marsh, MD